Study on demographic factors of discharge against medical advice in pediatric population

Background: Discharge against medical advice (DAMA) is of serious concern among the pediatrics population. Parent(s)/guardians understanding about the disease and various other factors play role in their decision of DAMA. The aim of this study is to know the prevalence of DAMA in a tertiary care center and to observe the gender stratification in DAMA.Methods: A retrospective survey of medical records of children discharge against medical advice during the period January 2017 to January 2019. Demographic data, length of hospital stay, clinical diagnosis and procedure refused was collected.Results: Total 12977 were discharged during the study period of which, 387 children were DAMA, prevalence of DAMA was 2.9%, male to female ratio among DAMA patients is 1.2:1. The mean length of stay was 4.8 days. Among the DAMA patients' newborns were predominant (61.6 %), p value = 0.0001, highly significant. No significant difference with respect to age and gender (p value = 0.535). Out of 370 DAMA patients, 211 patients who required further investigations and procedure was refused by parents/guardians (p value = 0.0001) highly significant. Phototherapy refusal was most common among newborn (59.7%), followed by neuroimaging and lumbar puncture in children (10.9%).Conclusions: DAMA was observed more among the newborns compared to infants, toddlers and children. Among newborns, phototherapy refusal was most common. In infants and children neuroimaging and lumbar puncture was the most commonly refused procedure. There was no gender bias.

Intention and satisfaction of people aged 18 to 25 years to seek medical advice in primary medical institutions in Zhejiang Province / 预防医学

Objective @#To analyze the status and influencing factors of the intention of people aged 18 to 25 years to primary medical institutions and their satisfaction for health services in Zhejiang Province, so as to provide basis for the improvement of health services in primary medical institutions.@*Methods@#During November and December in 2019,the 18-25 year-old people in Zhejiang Province were recruited to investigate the general information, intention to seek medical advice and satisfaction for health services in primary medical institutions through WeChat. Logistic regression was performed to analyze the influencing factors of the intention and the satisfaction. Importance matrix was used to analyze the key drivers of the satisfaction. @*Results@#Among the 620 people surveyed, with a response rate of 93.37%, 142 (22.90%) chose primary medical institutions for advice. Actually 516 (83.23%) people went to primary medical institutions last year, and 384 ( 74.42% ) of them were satisfied with the health services. The results of multivariate logistic regression analysis showed that the people aged 18-25 years who were under the new rural cooperative medical care system ( OR=3.062, 95%CI: 1.745-5.373 ) and who had records in community health centers ( OR=0.547, 95%CI: 0.308-0.970 ) were more likely to go to primary medical institutions for medical advice; the ability of doctors ( OR=1.478, 95%CI:1.168-1.871 ) ,the drug notification by medical staff ( OR=1.308, 95%CI: 1.065-1.606 ) , routine examination items ( OR=1.523, 95%CI: 1.227-1.889 ) , the ways of payment ( OR=1.168, 95%CI: 1.017-1.340 ) , the comfort of environment ( OR=1.785, 95%CI: 1.437-2.219 ) and the bulletin boards of health knowledge ( OR=1.302, 95%CI: 1.086-1.561 ) were associated with the satisfaction. The results of importance matrix analysis showed that the ability of doctors and routine examination items were the priorities to improve, followed by the drug notification by medical staff; the comfort of environment had competitive advantages; the ways of payment and the bulletin boards of health knowledge needed to be further analyzed. @*Conclusions@#The 18-25-year-old people in Zhejiang Province were less intended to seek medical advice in primary medical institutions, which was associated with the type of medical insurance and records in community health centers. They were satisfied with the health services, the ability of doctors and routine examination items were the key drivers.

Frequency and Causes of Discharge against Medical. Advice in children

Introduction: Discharging with personal satisfaction is one of the main problems in hospitalization, when the patient leaves the hospital sooner than the doctor's advice. This will exacerbate the disease and increase the risk of hospital re-admittance. In this regard, more attention should be given to children because they are not able to understand the above meaning or participate in decision making. Materials and Methods: In this descriptive cross-sectional study, all children who were discharged due to personal satisfaction from the hospital were included. The 4-page checklist for the various causes of "leaving the hospital despite medical advice" was divided into three sections: Causes related to the patient's own issues, causes related to the hospital medical staff and the causes of the hospital situation, and a page of demographical variables included gender, age and history of hospitalization and ward of hospitalization. Results: A total of 310 cases (7.4%) were discharged with personal satisfaction of their parents. The most important factor linked to discharge with personal satisfaction was the poor economic condition of parents. In terms of factors related to the medical staff, the lack of proper handling of the nurse and then the doctor were the most important factors for discharge. Conclusion: It seems that economic issues are the most important factor in the discharge of children with parental consent of parents. On the other hand, factors such as unacceptable and unpopular behavior of nurses and doctors play crucial role in this phenomenon. Parents who are under intense psychological stress due to economic problems and child illness can be at risk of developing this phenomenon if they are not mentally supported by health staffs

Prevalence of elderly patients who refuse to get discharge from coronary intensive care unit in a tertiary care hospital of North India: a pilot study

Background: The elderly population ≥60 years is increasing as the life span is increasing. So is the number of elderly patients who are refusing to get discharge from the hospital is also increasing. Authors are conducting this study in the elderly population who want to stay against medical advice.The aim to find the prevalence of elderly patients who refuse to get discharge from Coronary Care Unit (CCU) in a Tertiary care hospital of North IndiaMethods: A retrospective, observational study conducted in patients of age ≥60 years admitted to the coronary intensive care unit of a tertiary health care centre who refused discharge from the unit, were included in the study. Results: Of the 575 patients 44(7.65%) were willing to stay against medical advice. Of these 24(54.5%) were males and 20(45.5%) females. 6(13.6%) patients were terminally ill suffering from malignancies. Among all the patients who were willing to stay against medical advice, 8(18.2%) were covered by some health insurance scheme of either State or Central Government. 3(6.8%) patients were discharged after 24 hours, 22(50%) patients after 48 hours, 14(31.9%) patients after 72 hours and 5(11.3%) patients after 96 hours of advising discharge from hospital.Conclusions: As the intensive care beds at tertiary healthcare level are limited, the treatment of other salvageable sick patients who need the intensive care is affected by the unnecessary stay in hospital. Apart from the worsened nurse to patient ratio this increases the cost of treatment. This is need of hour to provide safe environment for the elderly outside the hospital settings and increase resources to provide better homecare.

Compliance to medical advice among patients having non-communicable disease in Jamnagar, Gujarat

Background: The low compliance by patients with non-communicable diseases to treatment and medical advice is a major therapeutic challenge. WHO study estimates that only 50% of patients suffering from chronic diseases in developed countries follow treatment recommendations. Aims & Objective: To estimate compliance to medical advice among patients with non-communicable diseases and to find out association between various socio-demographic factors and compliance to medical advice. Materials & Methods: It was a community based cross sectional study. Total 450 subjects (225 each from Urban and rural areas of the district) were studied using pre-tested and semi-structured questionnaire. Result: Medicines were taken as prescribed by 71.78% participants. Dose was missed on previous day and once in previous week by 26% and 35.78% participants respectively. Adherence to medical advice was found among 43.33% participants. Proportion of adherence was significantly low among participants more than 50 years of age (38.40%), among males (35.74%), among financially dependent (39.30%) and those having disease since 6years or more (36.92%). Conclusion: Large number of study subjects were found to be non-compliant to medical advice and also the compliance was lower in participants more than 50 years of age, among males and among those who were financially dependent. These risk groups may be targeted through counselling or health education sessions to increase compliance.

Status and strategies of oral health service demand and medical treatment utilization among 3- to 5-year-old preschool children in Jiangxi province / 华西口腔医学杂志

OBJECTIVE@#This study aimed to investigate the oral health service needs and dental treatment among 3-year-old to 5-year-old preschool children in Jiangxi province and provide data to support the development of relevant oral health policies, enhance the oral health service utilization and visit rate, and optimize oral manpower and service resources.@*METHODS@#A total of 2 880 preschool children were selected via stratified cluster sampling. Dental examination methods and criteria according to the fourth national oral health epidemiological survey were adopted. Excel 2007 and SPSS 19.0 softwares were used for statistics analysis. Chi-square test and logistic regression analysis were performed.@*RESULTS@#The caries prevalence was 49.13% (1 415/2 880) among the 2 880 cases of 3-
year-old to 5-year-old preschool children in Jiangxi province, approximately 53.37% (1 537/2 880) of which possessed oral health service needs. The parents of younger children assessed the oral situation better in older age than in their younger years (P<0.05), which was better in urban children than in rural children (P<0.05). The visiting rate of all the respondents was 12.33% (355/2 880), while the visiting rate of children with oral diseases was 17.31% (266/1 537). The top three reasons why patients did not visit the dentist were as follows: children's teeth have no problem, the teeth damage in teeth was considerably minimal, and primary teeth would be replaced without the need for treatment. The influencing factors included lower visiting rate in females than in males (OR=0.499, 95%CI: 0.411-0.606) and lower visiting rates in rural areas than in urban areas (OR=0.428, 95%CI: 0.353-0.519). Subjects with poor oral health and high oral knowledge scores possessed high dental service visit rates.@*CONCLUSIONS@#The prevalence of caries in 3-year-old to 5-year-old preschool children in Jiangxi province is at a lower level than that in the national level. The proportion of the population actively seeking medical services is low, and their main purpose of treatment is to treat rather than prevention. Oral health education should be strengthened, and it should be incorporated to the contents of the kindergarten teacher training program to improve residents' awareness regarding children's oral health.

Evaluation of Standardized Usage of Oral Antidiabetic Agents in Inpatients' Prescriptions / 中国药师

Objective:To evaluate the standardized usage of oral antidiabetic agents in inpatients to provide reference for the pre -scription standardization .Methods:A retrospective study was used to evaluate the prescriptions of oral antidiabetic agents in inpatients during January and March in 2017 , and statistical analysis was conducted on drug usage and standardization evaluation .Results:There were 886 medication plans including 4,397 prescriptions, which involved in 13 kinds of antidiabetic agents .Metformin and acarbose a-gents were used most frequently .The non-standardization rate was 70.54％with 66.03％unlabeled accurate time for oral administra-tion and 4.51％ labeled wrong time for oral administration .Twelve antidiabetic agents existed non-standardized applications ( >50％) .Conclusion:The main problem in the non-standardized usage of antidiabetic agents is leaving the special time for oral adminis -tration of antidiabetic agents out of account , which not only affect the best efficacy , but also reduce patients ' compliance .It' s neces-sary to standardize the prescriptions of antidiabetic agents to improve the standardization of medication therapy .

Key functions of mobile medical APP used in China and suggestions for their development / 中华医学图书情报杂志

The functions of the top 15 medical APP were compared.Their major functions of medical advice, information service and medical service were analyzed.The key functions of mobile medical APP used in China were described with suggestions for their development.

Qualitative research on the effect of the implementation of electronic medical records based on electronic medical records / 中国实用护理杂志

Objective To explore the reasons for disharmony between medical staff and medical staff because of electronic clinical ordering,to specificate electronic medical order in ward in order to create a harmonious relationship between doctors and nurses. Methods The methods of qualitative research conducted in-depth interviews of 12 medical staff, field recordings and transcripts, and the method of content analysis were used. Results Two themes were sublimated:medical staff reasons:lack of communication between the medical staff;new doctors didn't have a good command of medical norms of specialist electronic orders; on the responsibility of checking the doctor's advice problems may lead to potential adverse events occurrence. System equipment reason: the electronic doctor's advice system set up the problem; the office computer quantity is insufficient. Conclusions Nonstandard electronic medical management leads to the disharmony of health care. It is suggested to standardize the management of electronic medical advice by implementation of the responsibility to avoid medical coupling errors. The health care workers need to strengthen communication, mutual understanding and forgiveness, in order to create a harmonious medical environment.

Abandono del hábito tabáquico tras un primer ingreso en el Servicio de Neumología / Smoking cessation after first admission in a respiratory unit

Some authors suggest that hospitalization is an ideal moment to stop smoking. It is unknown the outcome of smokers admitted for the first time in the pulmonology department, which interventions are carried out to achieve smoking cessation and which are the dropout rates once they are discharged. The purpose of this study is to analyze the impact of a first hospital admission in a service of Pneumology on smokers. Epidemiological variables, smoking habit, specialized interventions carried out on these subjects and rate of withdrawal after discharge were studied. It is necessary to train specialists to diagnose and treat the patient in the process, so that on every hospitalized smoker a cessation intervention should be carried out.

Algunos autores defienden que el ingreso hospitalario constituye un marco ideal para dejar de fumar. Se desconoce lo que sucede con los fumadores que ingresan por primera vez en el Servicio de Neumología, sobre las intervenciones que en ellos se lleva a cabo, así como sus tasas de abandono una vez que son dados de alta. El objetivo de este estudio es analizar el impacto que tiene un primer ingreso hospitalario en el Servicio de Neumología en sujetos fumadores. Conocer sus variables epidemiológicas, el hábito de tabáquico, las intervenciones que el personal médico especializado realiza sobre estos sujetos y las tasas de abstinencia posteriores al alta. Es necesario formar a los especialistas para diagnosticar y tratar al paciente en dicho proceso, de tal forma que sobre todo sujeto fumador hospitalizado se realice alguna intervención.

Analysis of the Result of Clinical Pharmacists' Investigation of Medical Advice / 中国药师

Objective:To explore the methods and the role of clinical pharmacists in the medical advice audit. Methods: The questionnaire was designed to analyze the results of the medical advice investigated by the clinical pharmacists from November 2011 to October 2012. Results:Totally 3 232 patients were in the use of antimicrobial drugs in a investigation of 14 675 patients in 178 724 medical advices, accounting for 22. 0% of the total number of the investigation;the use of antimicrobial agents in patients with medical advices of antimicrobial were 5 387, accounting for 3. 0% of the total number of the investigation;597 errors were detected and inter-vened, accounting for 0. 33% of the total number of the investigation;the main errors were dose errors, usage errors and repeated med-ication errors. Indication error and interaction error were more in the critically ill patients monitored by the clinical pharmacists than that in the general ward patients. Conclusion:Clinical pharmacists and ward pharmacists to participate medical advice review, partic-ularly to concern about the patients with medical advices of antimicrobial drugs, and to intervene reasonably in the dose errors, usage errors and repeated medication errors can improve the overall quality of the hospital pharmacist team, make sustainable development of rational use of drugs and reduce the risk of medication.

A patient who refused medical advice: The doctor and the patient should look for a common ground

Treatment refusal is a common encounter in clinical practice. The process of deciding to refuse treatment is often complex. It is our responsibility to try and understand this process of decision making and the underlying reasons for treatment refusal. Many of these reasons are often rational in the context where the decision is made. The patients could be making the best decision for themselves even if these decisions are not necessarily the best in our mind. We should at all times discuss our treatment options and assess their ability to make decisions in achieving common goals. These goals should balance our best treatment strategies and the patients’ best interest. This article discusses the reasons underlying treatment refusal and how we can achieve a common goal with our patients.

The differences of opinion on Boramae incident between physiscians and common people

BACKGROUND: Without available medical policy, up until now discharges against medical advice have occurred in th field of medicine in Korea. Seoul district court had convicted two physicians of crime because they had allowed a patient to discharge against medical advice, referred to as the Boramae incident in May of 1998. This shocked people in medical field as well as people and appeared in almost all newspapers and created a debate especially to physicians. The purpose of this study was to evaluate the differences of opinion of this incident between physicians and common people. METHODS: Ninety-nine physicians and ninety-nine common people were questioned from September 1 to September 30, 1998 about sociodemographic characteristics and opinion of this event. RESULTS: The mean age of the physician group, the non-physician group was 38.12+/-11.2, 38.5+/-11.1, respectively. Each group consisted of 87.9 percent, men and 12.1 percent, women. There were no differences between physicians and common people in experiences of discharges against medical advice in their families, decisions on Boramae-like incidents that could occur in the near future, and causes of discharges against medical advice. The physician group had more awareness rate of this incident than the non-physician group, and insisted more on the needs of methods to prevent recurrence. In opinion of the judgement, 5.1 percent of non-physician group agreed to conviction of Seoul district court. 22.2 percent of the non-physician group was of the opinion that this incident will affect patient care positively, about patient wifes decision, 21.2 precent of non-physician group considered that she made an imprudent decision. CONCLUSION: There were significant, differences between physicians and common people in the awareness of this incident, opinion on th judgement, needs of methods to prevent recurrence, the influence of this incident on patient care in the future, opinion of patient wifes decision, exceptional experiences of discharges against medical advice in a family, decisions on Boramae-like incidents that can occur in the near future, and causes of discharges against medical advice.

Neonatal Statistics of Korea in 1996: Collective Results of Live - Births , Neonatal Mortality , and Incidence of Dischage Against Medical Advice at 64 Hospitals

PURPOSE: To evaluate the nation-wide results of statistics related to the neonatal period of 1996, we collected data of a total of 64 hospitals in Korea (42 university hos- pitals and 22 general hospitals). METHODS: We obtained the results of 129,175 inboms and 9,379 outborns, and analyzed the statistics of live-births, ig, distribution of live-births by gestational age and birth weight, incidence of pre-term infants and low birth weight infants (LBWI), neonatal mortality, and incidence of discharge against medical advice (DAMA). RESULTS: According to birth weight, incidence of LBWI, normal birth weight, infant and high birth weight infants was 3.6%, 86.6% and 9.8%, respectively in the case of inborn group. But incidence of LBWI was higher in outborn group as compared with the inbom group. According to gestational age, incidence of preterm, term, and post-term was 11.1%, 87.1Yo and 1.8% respectively in the inbom group. The incidence of preterm in outborn group was higher than that of inborn group, because of the influnce of transpor- tation of high risk neonates to 2nd or 3rd levels of neonatal intensive care units (NICU). Overall neonatal mortality per 1,000 live-births was 9.3 in the inborn group amd 37.6% in the outborn group. These data revealed a high neonatal mortality, because the numbers of DAMA cases was also included. The incidence of DAMA was 0.44% and 1.15% in inborn and outborn groups, respectively. The percentage of the DAMA among the numbers of neonatal mortality was 47.2-48.8M in the inborn group. CONCLUSIONS: We obtained the statistics related to live-birth, incidence of prematurity and LBWI, neonatal mortality, and incidence of DAMA in Korea. The data revealed high levels of neonatal mortality (which included the sum of neonatal death and the number of DAMA) and incidence of DAMA in Korea at present. To achieve a low-level of neonatal mortality, more efforts to decrease the incidence of DAMA are needed. Also, a greater facility for NICU and a stronger support system from a nation-wide govemment policy and system of insurance are seen to be necessary.

Investigation into and analysis of 552 outpatients / 中华医院管理杂志

Objective To find out about patients needs, better deliver patient oriented care, and enhance patients satisfaction towards the service. Methods An investigation by questionnaire was made into 552 randomly selected outpatients with regard to the factors influencing patients selection of hospitals when seeking medical service and the needs of outpatients when waiting to see the doctors. Results Among the major factors influencing patients selection of hospitals when seeking medical service are the medical expertise of doctors and patients confidence in them. Spread of knowledge about health, constant notice to patients waiting of how things are going, introduction to specialists, and provision of signs indicating the service process are areas of service that patients waiting to see the doctors hope to get or see improved. Conclusion Enhancing the medical expertise and the overall quality of the medical staff, intensifying the awareness of quality service and standardizing medical behavior are among the major steps that hospitals can take to deliver patient oriented service.